[A case of anesthesia for a patient with a huge pheochromocytoma accompanying difficulty in hemodynamics control]

A 33-year-old man with diabetes mellitus developed a left pheochromocytoma, 9 cm diameters in size, of adrenalin predominance type. He underwent laparoscopic adrenalectomy. Anesthesia was induced with propofol and vecuronium, and maintained with continuous infusion of propofol. Lopivacaine was also used for epidural anesthesia. From the beginning of the operation, blood pressure was well controlled using prostaglandin E1 and landiolol continuously. However, the bleeding from the adrenal vein occurred in the middle of the operation. This incidence obliged us to alter the operation from laparoscopic to open surgery. It turned difficult to control blood pressure although antihypertensive drugs, such as prostaglandin E1, phentolamine and landiolol, were used. However, it was difficult to suppress unexpected high blood pressure and tachycardia with alteration of the operative procedure.